China needs to be cautious on controversial trend to change guidelines for people with diabetes and continue focus on aggressive, targeted blood pressure lowering treatment

New research appearing today in the Journal of American Medical Association indicates that starting blood pressure lowering in diabetes patients with mildly elevated blood pressure and treating it more aggressively provides important health benefits such as reduced risk of stroke and diabetic eye disease.

In one of the most comprehensive systematic reviews of research in this area, researchers from The George Institute for Global Health are challenging recent changes to US and European guidelines that have relaxed previous recommendations of lower blood pressure targets in people with diabetes.

Globally, it is estimated that about 400 million people have diabetes putting them at high risk of heart disease, stroke, kidney disease and eye disease. In China, where around 100 million people have the condition, stroke is a particularly more common complication as compared with Caucasian population.

Urging for guidelines around the world to reflect the new findings, author Professor Anushka Patel, Chief Scientist of The George Institute for Global Health, said this research provides fundamental evidence about how blood pressure should be treated in people with diabetes.

“Although we did not see beneficial effects on risks of death and heart disease with lower blood pressure targets, our analyses indicate that many patients with diabetes and low-normal blood pressure levels will still benefit from blood pressure lowering, by reducing their risks of stroke, diabetic eye disease and early kidney disease,” says Professor Patel.

“This is a big deal: recent changes to influential guidelines in the US and Europe go in the wrong direction and can lead to many more people being inadequately treated. We urgently call for these recent changes to guidelines to be modified and for all guidelines around the world to consistently reflect the evidence so patients with diabetes are receiving the best possible treatment.”

“When considering blood pressure targets in these patients, it’s critical to make an individualised assessment of the balance between the benefits of more intensive treatment and any adverse effects of increasing medication,” says Professor Patel. “This research indicates that many people with diabetes may have net benefits with more aggressive treatment.”

Diabetes expert, Professor Ji, Chief Scientist of The George Institute at Peking University Health Center, said the increasing prevalence of diabetes globally and across China is an “unfolding nightmare” and that treatment recommendations need to reflect the best available evidence.

Professor Ji, who was not involved in the study, said he was very pleased the review had been carried out. “I expect this study to add more evidence for developing guidelines for the treatment of people with diabetes, and for this to translate to appreciable effects on the health of people with diabetes.”

“I have been paying increasing attention on the trend to advocate higher blood pressure targets as reflected by recent changes to guidelines in Europe and the US and this study provides the evidence needed to reconsider this.” Professor Ji added.

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